Maximal Heart Rate Research Articles

Aquatic High-Intensity Interval Deep Water Running Influence on Cardiometabolic Health and Cognitive Psychological Responses in Women.

To investigate the effects of an 8-wk AHIIT-DWR intervention compared with land-based HIT training (LHIIT) on cardiometabolic health, cognitive, and psychological outcomes in inactive elderly women. Seventy inactive elderly women aged 60 yr or above were randomly assigned into two groups: AHIIT-DWR and LHIIT. The AHIIT-DWR group engaged in DWR sessions comprising 30 min of interval training, consisting of ten 2-min exercise bouts at 80%-90% of their maximal heart rate (HR max ), with 1-min active recovery at 70% HR max between bouts, for two sessions per week, for 8 wk. The LHIIT group performed treadmill running at the same intensity. Both groups showed similar cardiovascular fitness, maximal aerobic capacity (V̇O 2max ), HR max , and RER improvement ( P > 0.05), whereas AHIIT-DWR showed a significant improvement in aerobic capacity minute ventilation (V̇E), metabolic equivalents (METs), and O 2 pulse ( P < 0.05) over the 8-wk intervention. Both AHIIT-DWR and LHIIT significantly decreased triglycerides, total cholesterol, HDL, and LDL postintervention ( P < 0.05). No significant group differences were observed for cognitive function assessed by MMSE and MOCA ( P > 0.05). Both groups showed similar enjoyment levels, self-efficacy scores, and high adherence rates (>90%). Our study suggests that AHIIT-DWR can elicit a similar improvement in cardiorespiratory health, metabolic blood markers, cognitive function assessed by MMSE and MOCA, and psychological responses as LHIIT in inactive elderly women.

Individual variability and consistency of post-exercise energy and macronutrient intake, appetite sensations, and food reward in healthy adults

Limited evidence is available about the variability of appetitive responses within individuals after an acute bout of exercise. The present study aimed to assess the consistency and individual variability of post-exercise appetitive responses in healthy individuals. Twenty participants (10 females, 23.9 ± 4.1 years, 22.5 ± 2.0 kg m−2) joined the laboratory to perform four sessions separated by a minimum of 5 days: i) a control session with a rest period before and an ad libitum lunch (REST), and ii) three identical exercise sessions (EX) with a 30-min moderate-intensity (60–70% of predicted maximal heart rate) walking bout ending 25 min before the ad libitum lunch. Subjective appetite sensations were assessed before and after the meal at regular intervals, and satiety quotients were calculated. Food reward was assessed by the Leeds Food Preference Questionnaire before and after lunch. For each EX session, the difference with the REST session was calculated (Δ = EX – REST). Energy and macronutrient intake were consistent in response to exercise (all intraclass correlation coefficients (ICC) > 0.8) while results showed that post-exercise subjective appetite sensations and satiety quotients varied across the three EX sessions (almost all ICC < 0.7). Food reward was overall consistent in response to exercise before the test meal but not after. When considering the changes (Δ), the results showed no or poor consistency for most of the appetitive outcomes. To conclude, energy and macronutrient intake, as well as pre-meal food reward, are consistent after exercise in healthy individuals, while subjective appetite sensations are not stable within individuals across the sessions. Regarding the variations from REST to EX sessions, the results suggest that the individual changes observed are only random day-to-day variations.

Jump Roping High-Intensity Interval Training Enhances Vascular Function in Adults with Overweight/Obesity

A few studies have shown that body-weight- and laboratory-based high-intensity interval training (HIIT) effectively improves endothelial function. However, the effect of HIIT in the form of jump roping that significantly increases vertical ground reaction force on endothelial function remains unknown. Thus, the objective of this study was to determine the effects of a 12-week jump roping exercise programme on vascular function in adults with overweight/obesity. Twenty young adults with overweight/obesity were randomly assigned to the exercise or control group. The exercise group performed 12 intervals jump roping HIIT – 1 minute at 85%–95% maximal heart rate (HRmax) and 1 minute at 50%–70% HRmax – for 12 weeks (five sessions per week). The control group was asked to maintain the usual lifestyle pattern throughout the study period. The outcome measures were per cent flow-mediated dilation (%FMD), baseline artery diameter (FMDbase), peak artery diameter (FMDpeak), mean blood flow velocity (MBFV) and per cent body fat (%BF). Results revealed that there was a significant group × time interaction for %FMD, FMDpeak and MBFV after the intervention (all P &lt;0.05). There was no significant group × time interaction for the other variables. There were no significant changes in the outcome variables between pre- and post-intervention and between the groups (all P &gt;0.05), except for %FMD. In conclusion, jump roping HIIT increased %FMD, FMDpeak and MBFV, indicating the cardiovascular-protective effects of this approach in adults with overweight/obesity.

24-h continuous non-invasive multiparameter home monitoring of vitals in patients with Rett syndrome by an innovative wearable technology: evidence of an overlooked chronic fatigue status.

Sleep is disturbed in Rett syndrome (RTT), a rare and progressive neurodevelopmental disorder primarily affecting female patients (prevalence 7.1/100,000 female patients) linked to pathogenic variations in the X-linked methyl-CpG-binding protein 2 (MECP2) gene. Autonomic nervous system dysfunction with a predominance of the sympathetic nervous system (SNS) over the parasympathetic nervous system (PSNS) is reported in RTT, along with exercise fatigue and increased sudden death risk. The aim of the present study was to test the feasibility of a continuous 24 h non-invasive home monitoring of the biological vitals (biovitals) by an innovative wearable sensor device in pediatric and adolescent/adult RTT patients. A total of 10 female patients (mean age 18.3 ± 9.4 years, range 4.7-35.5 years) with typical RTT and MECP2 pathogenic variations were enrolled. Clinical severity was assessed by validated scales. Heart rate (HR), respiratory rate (RR), and skin temperature (SkT) were monitored by the YouCare Wearable Medical Device (Accyourate Group SpA, L'Aquila, Italy). The average percentage of maximum HR (HRmax%) was calculated. Heart rate variability (HRV) was expressed by consolidated time-domain and frequency-domain parameters. The HR/LF (low frequency) ratio, indicating SNS activation under dynamic exercise, was calculated. Simultaneous continuous measurement of indoor air quality variables was performed and the patients' contributions to the surrounding water vapor partial pressure [PH2O (pt)] and carbon dioxide [PCO2 (pt)] were indirectly estimated. Of the 6,559.79 h of biovital recordings, 5051.03 h (77%) were valid for data interpretation. Sleep and wake hours were 9.0 ± 1.1 h and 14.9 ± 1.1 h, respectively. HRmax % [median: 71.86% (interquartile range 61.03-82%)] and HR/LF [median: 3.75 (interquartile range 3.19-5.05)] were elevated, independent from the wake-sleep cycle. The majority of HRV time- and frequency-domain parameters were significantly higher in the pediatric patients (p ≤ 0.031). The HRV HR/LF ratio was associated with phenotype severity, disease progression, clinical sleep disorder, subclinical hypoxia, and electroencephalographic observations of multifocal epileptic activity and general background slowing. Our findings indicate the feasibility of a continuous 24-h non-invasive home monitoring of biovital parameters in RTT. Moreover, for the first time, HRmax% and the HR/LF ratio were identified as potential objective markers of fatigue, illness severity, and disease progression.

Association of Smartwatch-Based Heart Rate and Physical Activity With Cardiorespiratory Fitness Measures in the Community: Cohort Study.

Resting heart rate (HR) and routine physical activity are associated with cardiorespiratory fitness levels. Commercial smartwatches permit remote HR monitoring and step count recording in real-world settings over long periods of time, but the relationship between smartwatch-measured HR and daily steps to cardiorespiratory fitness remains incompletely characterized in the community. This study aimed to examine the association of nonactive HR and daily steps measured by a smartwatch with a multidimensional fitness assessment via cardiopulmonary exercise testing (CPET) among participants in the electronic Framingham Heart Study. Electronic Framingham Heart Study participants were enrolled in a research examination (2016-2019) and provided with a study smartwatch that collected longitudinal HR and physical activity data for up to 3 years. At the same examination, the participants underwent CPET on a cycle ergometer. Multivariable linear models were used to test the association of CPET indices with nonactive HR and daily steps from the smartwatch. We included 662 participants (mean age 53, SD 9 years; n=391, 59% women, n=599, 91% White; mean nonactive HR 73, SD 6 beats per minute) with a median of 1836 (IQR 889-3559) HR records and a median of 128 (IQR 65-227) watch-wearing days for each individual. In multivariable-adjusted models, lower nonactive HR and higher daily steps were associated with higher peak oxygen uptake (VO2), % predicted peak VO2, and VO2 at the ventilatory anaerobic threshold, with false discovery rate (FDR)-adjusted P values <.001 for all. Reductions of 2.4 beats per minute in nonactive HR, or increases of nearly 1000 daily steps, corresponded to a 1.3 mL/kg/min higher peak VO2. In addition, ventilatory efficiency (VE/VCO2; FDR-adjusted P=.009), % predicted maximum HR (FDR-adjusted P<.001), and systolic blood pressure-to-workload slope (FDR-adjusted P=.01) were associated with nonactive HR but not associated with daily steps. Our findings suggest that smartwatch-based assessments are associated with a broad array of cardiorespiratory fitness responses in the community, including measures of global fitness (peak VO2), ventilatory efficiency, and blood pressure response to exercise. Metrics captured by wearable devices offer a valuable opportunity to use extensive data on health factors and behaviors to provide a window into individual cardiovascular fitness levels.

Determining the Effects of a 12-Week Moderate Intensity Circuit Exercise Program on Body Composition and Physical Fitness among Overweight Women of Working Age

Objectives. The study aimed to examine the effects of a 12-week moderate-intensity circuit exercise program on body composition and physical fitness among overweight women of working age. Materials and methods. Twenty-nine overweight women of working age were divided into two groups: the control group (CG, n = 14) had a normal daily life, and the moderate intensity circuit exercise group (MICE, n = 15) underwent training that included 3 sessions of MICE (40–50 seconds followed by 60 seconds of rest for each exercise and 90 seconds of recovery between sessions at 64–76% of maximum heart rate). The training was conducted for 60 minutes per day, three days per week. Body composition and physical fitness were measured before (2 days prior) and after (2 days post) a 12-week training period. Results. After the 12-week training, the MICE showed a considerable improvement in a number of key health indicators, including body weight, BMI, fat mass, skeletal muscle mass, visceral adipose tissue, total energy expenditure, resting energy expenditure, waist circumference, and waist-to-hip ratio (-0.65%, -0.73%, -2.16%, 2.53%, -7.12%, 10.85%, 0.71%, -3.13%, and -2.67%, respectively, p &lt; 0.05) when compared to the CG. Similarly, the MICE demonstrated a significantly larger improvement in the sit and reach test, the back extension test, the hand grip strength of the right hand, hand grip strength of the left hand, leg strength, the 60-second chair stand test (also known as sit-to-stand test), and the maximum oxygen consumption (18.98%, 16.53%, 10.69%, 7.68%, 9.97%, 26.25%, and 8.87%) compared to the CG (-4.10%, -1.19%, -0.26%, -1.53%, -1.44%, 0.24%, and -0.70%), respectively. Conclusions. Moderate-intensity circuit exercise has been found to have positive effects on improving body composition and physical fitness in overweight working women. Thus, the implementation of MICE with appropriate sessions, resting, duration, and training periods can achieve maximum benefit.

Determining the Effects of a 12-Week Moderate Intensity Circuit Exercise Program on Body Composition and Physical Fitness among Overweight Women of Working Age

Objectives. The study aimed to examine the effects of a 12-week moderate-intensity circuit exercise program on body composition and physical fitness among overweight women of working age. Materials and methods. Twenty-nine overweight women of working age were divided into two groups: the control group (CG, n = 14) had a normal daily life, and the moderate intensity circuit exercise group (MICE, n = 15) underwent training that included 3 sessions of MICE (40–50 seconds followed by 60 seconds of rest for each exercise and 90 seconds of recovery between sessions at 64–76% of maximum heart rate). The training was conducted for 60 minutes per day, three days per week. Body composition and physical fitness were measured before (2 days prior) and after (2 days post) a 12-week training period. Results. After the 12-week training, the MICE showed a considerable improvement in a number of key health indicators, including body weight, BMI, fat mass, skeletal muscle mass, visceral adipose tissue, total energy expenditure, resting energy expenditure, waist circumference, and waist-to-hip ratio (-0.65%, -0.73%, -2.16%, 2.53%, -7.12%, 10.85%, 0.71%, -3.13%, and -2.67%, respectively, p &lt; 0.05) when compared to the CG. Similarly, the MICE demonstrated a significantly larger improvement in the sit and reach test, the back extension test, the hand grip strength of the right hand, hand grip strength of the left hand, leg strength, the 60-second chair stand test (also known as sit-to-stand test), and the maximum oxygen consumption (18.98%, 16.53%, 10.69%, 7.68%, 9.97%, 26.25%, and 8.87%) compared to the CG (-4.10%, -1.19%, -0.26%, -1.53%, -1.44%, 0.24%, and -0.70%), respectively. Conclusions. Moderate-intensity circuit exercise has been found to have positive effects on improving body composition and physical fitness in overweight working women. Thus, the implementation of MICE with appropriate sessions, resting, duration, and training periods can achieve maximum benefit.

Despite plasticity, heatwaves are costly for a coral reef fish

Climate change is intensifying extreme weather events, including marine heatwaves, which are prolonged periods of anomalously high sea surface temperature that pose a novel threat to aquatic animals. Tropical animals may be especially vulnerable to marine heatwaves because they are adapted to a narrow temperature range. If these animals cannot acclimate to marine heatwaves, the extreme heat could impair their behavior and fitness. Here, we investigated how marine heatwave conditions affected the performance and thermal tolerance of a tropical predatory fish, arceye hawkfish (Paracirrhites arcatus), across two seasons in Moorea, French Polynesia. We found that the fish’s daily activities, including recovery from burst swimming and digestion, were more energetically costly in fish exposed to marine heatwave conditions across both seasons, while their aerobic capacity remained the same. Given their constrained energy budget, these rising costs associated with warming may impact how hawkfish prioritize activities. Additionally, hawkfish that were exposed to hotter temperatures exhibited cardiac plasticity by increasing their maximum heart rate but were still operating within a few degrees of their thermal limits. With more frequent and intense heatwaves, hawkfish, and other tropical fishes must rapidly acclimate, or they may suffer physiological consequences that alter their role in the ecosystem.

A novel higher performance nomogram based on explainable machine learning for predicting mortality risk in stroke patients within 30 days based on clinical features on the first day ICU admission

BackgroundThis study aimed to develop a higher performance nomogram based on explainable machine learning methods, and to predict the risk of death of stroke patients within 30 days based on clinical characteristics on the first day of intensive care units (ICU) admission.MethodsData relating to stroke patients were extracted from the Medical Information Marketplace of the Intensive Care (MIMIC) IV and III database. The LightGBM machine learning approach together with Shapely additive explanations (termed as explain machine learning, EML) was used to select clinical features and define cut-off points for the selected features. These selected features and cut-off points were then evaluated using the Cox proportional hazards regression model and Kaplan-Meier survival curves. Finally, logistic regression-based nomograms for predicting 30-day mortality of stroke patients were constructed using original variables and variables dichotomized by cut-off points, respectively. The performance of two nomograms were evaluated in overall and individual dimension.ResultsA total of 2982 stroke patients and 64 clinical features were included, and the 30-day mortality rate was 23.6% in the MIMIC-IV datasets. 10 variables (“sofa (sepsis-related organ failure assessment)”, “minimum glucose”, “maximum sodium”, “age”, “mean spo2 (blood oxygen saturation)”, “maximum temperature”, “maximum heart rate”, “minimum bun (blood urea nitrogen)”, “minimum wbc (white blood cells)” and “charlson comorbidity index”) and respective cut-off points were defined from the EML. In the Cox proportional hazards regression model (Cox regression) and Kaplan-Meier survival curves, after grouping stroke patients according to the cut-off point of each variable, patients belonging to the high-risk subgroup were associated with higher 30-day mortality than those in the low-risk subgroup. The evaluation of nomograms found that the EML-based nomogram not only outperformed the conventional nomogram in NIR (net reclassification index), brier score and clinical net benefits in overall dimension, but also significant improved in individual dimension especially for low “maximum temperature” patients.ConclusionsThe 10 selected first-day ICU admission clinical features require greater attention for stroke patients. And the nomogram based on explainable machine learning will have greater clinical application.

Virtual reality as an engaging and enjoyable method for delivering emergency clinical simulation training: a prospective, interventional study of medical undergraduates

BackgroundIt is a requirement that medical students are educated in emergencies and feel well prepared for practice as a doctor, yet national surveys show that many students feel underprepared. Virtual reality (VR), combined with 360-degree filming, provides an immersive, realistic, and interactive simulation experience. Unlike conventional in-person simulation, it is scalable with reduced workforce demands. We sought to compare students’ engagement and enjoyment of VR simulation to desktop computer-based simulation.MethodsWe conducted a prospective, interventional, evaluation study. The study was carried out on final year medical students undertaking their Pre-Foundation Assistantship (n = 116) at Imperial College School of Medicine (ICSM) in London. We compared objective engagement, subjective engagement, and subjective enjoyment of VR simulation to desktop computer-based simulation using cardiac arrest and life-threatening asthma scenarios. Engagement was measured objectively using students’ physiological parameters, including heart rate and eye tracking, and facilitator observations using the validated ‘Behavioural Engagement Related to Instruction’ (BERI) protocol. Students’ subjective engagement and enjoyment levels were measured using a post-session survey.ResultsStudents’ maximum heart rates were significantly higher during VR simulation with a mean difference of 4.2 beats per minute (3.2 to 5.2, p < 0.001), and eye tracking showed they spent a significantly greater mean percentage of time of 6.4% (5.1 to 7.7, p < 0.001) focusing on the scenarios in VR compared to standard desktop. Qualitative data showed students enjoyed and felt engaged with the sessions, which provided a safe space for learning.ConclusionsOur study shows that students found VR simulations enjoyable and were more engaged compared to standard desktop simulation. This suggests that 360-degree VR simulation experiences provide students with immersive, realistic training, which is scalable, giving them the unique opportunity to manage emergencies and work within emergency teams, which would not typically occur during traditional training.

Effect of Cardiovascular Endurance Training on the Exercise Capacity and Endurance in Children With Cerebral Palsy.

Cerebral palsy (CP) is non-progressive brain damage that occurs before, during, or shortly after birth. CP is associated with poor physical fitness, which is linked to health problems and the development of secondary illnesses like obesity, cardiovascular disease, and diabetes. Compared to healthy peers without CP, children with CP have considerably lower VO2 peaks, which reduces their performance and aerobic capacity. This study aimed to evaluate changes in exercise capacity and endurance among children with CP, as well as fatigue levels among their parents and caregivers, after participation in cardiovascular endurance training. This study included 16 children aged 7-12 years with CP (Gross Motor Function Classification System levels I, II, or III). Participants completed a 12-week cardiovascular endurance program consisting of 60-minute sessions three times weekly designed to achieve 64-95% of their heart rate maximum,based on the American College of Sports Medicine guidelines. Pre- and post-intervention measurements were recorded for the following: distance covered in a six-minute walk, maximal oxygen consumption (VO2 max) level, Early Activity Scale for Endurance rating, and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Fatigue Scale score and PROMIS Parent Proxy Scale and Fatigue Scale scores. Result: Upon completing the cardiovascular endurance training, the distance covered during a six-minute walk improved by 20.95 points, resting heart rate by 5.19 points, VO2 max by 0.06 points, Early Activity Scale for Endurance by 4.06 points, PROMIS Pediatric Fatigue Scale by 7.29 points, PROMIS Parent Proxy Scale by 6.81 points, and PROMIS Fatigue Scale by 5.07 points. The maximum heart rate also showed a slight improvement of 0.33 points (p<0.01). A structured exercise protocol aimed at improving cardiovascular endurance can benefit children with CP by improving their exercise capacity and endurance, which in turn can help decrease fatigue levels among their parents and caregivers.

Absence of Monotony and Strain Effects on Referees' Physical Performance During International Basketball Federation World Cup Basketball Competition.

The study aimed to conduct a comparative analysis of physical performance indicators and assess the levels of performance monotony and strain experienced by basketball referees. The study involved the participation of 12 basketball referees (mean age: 40.0 [4.9]y) affiliated with the International Basketball Federation. The investigation was carried out throughout 2 density tournaments, wherein the maximum heart rate, average heart rate, performance monotony, and performance strain were documented for 3 variables. The findings indicated significant variations in the mean heart rate, maximum heart rate, total distance monotony, total distance strain, the total number of sprints monotony, the total number of sprints strain, calories monotony, and calories strain (P < .05). Decreasing the density of elite-level basketball competitions has been observed to reduce the monotony and strain experienced by referees. However, this action does not increase motion distance or speed zones. The environmental stressors experienced by senior-level athletes (World Cup) differ from those encountered by younger athletes (World Cup Under 19). Further investigation is required to ascertain the potential effects of competition monotony and strain on decision-making processes and the overall quality of refereeing.

Differences and Risk Factors of Peripheral Blood Immune Cells in Patients with Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a respiratory disorder characterized by chronic intermittent hypoxia and fragmented sleep, leading to inflammatory response and oxidative stress. However, the differences in immune inflammatory response in OSA patients with different severity remain unclear. This study aims to examine the differences in peripheral blood immune cells and their risk factors in OSA patients. A total of 277 snoring patients from the Sleep Respiratory Disorder Monitoring Center of Zhongnan Hospital of Wuhan University were recruited in this study. According to the diagnosis and severity criteria of OSA, the included patients were further divided into simple snoring, mild, moderate, and severe groups. Peripheral blood immune cell counts including white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, basophils, red blood cells, platelets, and polysomnography indicators were collected from the patients. Compared with simple snoring patients, the OSA patients had increased circular monocyte and basophil count levels. In addition, correlation analysis results indicated that monocyte count was positively associated with chronic obstructive pulmonary disease (COPD), smoking, apnea-hypopnea index (AHI), the longest apnea duration, and Oxygen desaturation index (ODI), and negatively correlated with average SpO2 in snoring patients. Finally, multiple linear regression analysis revealed that AHI, COPD, smoking, and maximum heart rate were independent predictors of monocyte count. OSA patients had a significant increase in their peripheral blood monocyte count. AHI, COPD, smoking, and maximum heart rate were risk factors for increased peripheral blood monocyte count in OSA patients. These findings suggest that peripheral blood monocytes can be considered an inflammatory biomarker of OSA.

No Sex Differences in Perceptual Responses to High-Intensity Interval Training or Sprint Interval Training.

Coe, LN and Astorino, TA. No sex differences in perceptual responses to high-intensity interval training or sprint interval training. J Strength Cond Res 36(6): 1025-1032, 2024-High-intensity interval training (HIIT) elicits similar and, in some cases, superior benefits vs. moderate-intensity continuous training (MICT). However, HIIT is typically more aversive than MICT because of the higher intensity and in turn, greater blood lactate accumulation (BLa). This study explored potential sex differences in perceptual responses to acute HIIT and sprint interval training. Fifteen men (age and V̇O2max = 29 ± 8 years and 39 ± 3 ml·kg-1·min-1) and 13 women (age and V̇O2max = 22 ± 2 years and 38 ± 5 ml·kg-1·min-1) who are healthy and recreationally active initially underwent testing of maximal oxygen uptake (V̇O2max) on a cycle ergometer. In randomized order on 3 separate occasions, they performed the 10 × 1-minute protocol at 85% of peak power output, 4 × 4-minute protocol at 85-95% maximal heart rate (%HRmax), or reduced exertion high intensity interval training consisting of 2 "all-out" 20-second sprints at a load equal to 5% body mass. Before and throughout each protocol, rating of perceived exertion (rating of perceived exertion [RPE] 6-20 scale), affective valence (+5 to -5 of the Feeling Scale), and BLa were assessed. Five minutes postexercise, enjoyment was measured using the Physical Activity Enjoyment scale survey. Results showed no difference in RPE (p = 0.17), affective valence (0.27), or enjoyment (p = 0.52) between men and women. Blood lactate accumulation increased in response to all protocols (p < 0.001), and men showed higher BLa than women (p = 0.03). Previous research suggests that interval exercise protocols are not interchangeable between men and women, yet our data reveal that men and women having similar V̇O2max exhibit no differences in perceptual responses to interval exercise.

Skin sympathetic nerve activity in symptomatic and asymptomatic paroxysmal atrial fibrillation

BackgroundThe causes of symptoms in patients with paroxysmal atrial fibrillation (AF) remains unclear. ObjectiveThe purpose of this study was to correlate the magnitudes of skin sympathetic nerve activity (SKNA) with symptoms in patients with AF. MethodsWe prospectively enrolled patients with symptomatic paroxysmal AF for ambulatory electrocardiography and SKNA recording. Heart rhythms at the time of symptoms were categorized as AF or normal sinus rhythm (NSR). Maximal and average skin sympathetic nerve activity (aSKNA) and heart rate (HR) were compared between symptomatic and asymptomatic AF and NSR episodes using mixed effects models to account for within-patient correlations. ResultsAmong the 31 enrolled patients, 16 (52%) had at least 1 episode of AF, and 24 (77%) endorsed symptoms during the monitoring period. Compared with asymptomatic AF episodes, symptomatic AF episodes had higher maximal aSKNA (1.260 [interquartile range (IQR) 1.114–1.723] μV vs 1.108 [IQR 0.974–1.312] μV; P <0.001) and higher maximal HR (152 ± 24 bpm vs 132 ± 19 bpm; P <.001). Symptomatic NSR episodes were associated with higher maximal aSKNA (1.612 [IQR 1.287–2.027] μV vs 1.332 [IQR 1.033–1.668] μV; P = .001) and higher maximal HR (152 ± 24 bpm vs 105 ± 16 bpm; P <.001) than asymptomatic NSR episodes. Of the symptomatic episodes, 66 (73%) occurred during NSR and 24 (27%) during AF. All P values were obtained from mixed effects models. ConclusionSymptomatic episodes in patients with paroxysmal AF were more frequently associated with NSR than AF. Symptomatic AF and NSR episodes were associated with higher aSKNA than asymptomatic episodes. In patients with paroxysmal AF, symptoms correlate better with SKNA than heart rhythm.

A comparison of historical versus proposed physical employment standards for flight paramedics performing helicopter winch rescue.

Paramedics working in helicopter teams undertake water and land rescues. Historical assessments of role-related fitness were not developed using physical employment standards methodology. To compare the historical selection tests with new tests developed via contemporary scientific methodology. Candidates undergoing selection to the role of flight paramedic (n = 14; age 37±5 yrs, body mass index [BMI] 26±4 kg.m2) undertook existing paramedic selection tests on land and in water, measurements of task duration, maximum heart rate (HRmax), rate of perceived exertion (RPE6-20) and capillary blood lactate (Lacmax) were recorded. These results were compared to the same variables in experienced paramedics (n = 14; age 44±5 yrs, BMI 25±3 kg.m2) who undertook the new tests. Land task duration (existing 17±2 min vs. proposed 7±2 min, p < 0.05) HRmax (existing 186±13 b.min-1 vs. proposed 173±11 b.min-1, p < 0.05), and Lacmax (existing 23±3 mmol.L-1 vs. proposed 8±2 mmol.L-1, p < 0.05) were higher in the existing test compared to the proposed tests. Water task duration (existing 12±2 min vs. proposed 10±1 min, p < 0.05) was longer in the existing test, but HRmax (existing 166±18 b.min-1 vs. proposed 167±15 b.min-1, p = 0.90), Lacmax (existing 11±4 mmol.L-1 vs. proposed 11±4 mmol.L-1, p = 0.90) did not differ. RPE6-20 did not differ between groups for water or land. The historical land-based physical tests for paramedics differed from the proposed tests, however the water-based tests had similar duration and physiological demands. Use of tests not developed via established scientific methodologies risks eliminating candidates suitable to work in the role, or including candidates that are not.

EFEITOS DO PROGRAMA RECREATIVO DE FUTSAL NA QUALIDADE DE VIDA DE CRIANÇAS OBESAS

Introduction: Childhood obesity is considered the most prevalent chronic disease in the child population, impacting the early onset of associated diseases. These subjects are more susceptible to psychological problems and reduced quality of life, increasing depression rates both in childhood and in adult life. Objective: To verify the effect of recreational futsal programs on the quality of life of overweight and obese children. Methodology: Thirteen overweight and obese boys aged 8-12 years participated in a 12-week recreational futsal program composed of ~80-minute sessions two times a week at an intensity greater than 80% of the maximum heart rate. Quality of life was assessed using the PedsQL 4.0 questionnaire, which assesses physical, emotional, social, and school issues. Results: No significant differences were found for anthropometric variables (P&gt;0.05). The intervention improved the emotional dimension (68.7 ± 15.9 vs. 79.1 ± 18; P=0.03) in overweight and obese boys. Regarding the social dimension (64.4 ± 13.7 vs. 63.7 ± 23.5; P&gt;0.05), physical (68.3 ± 24.6 vs. 75.5 ± 18.7, P&gt;0.05), and school (71.1 ± 22.8 vs.: 72.2 ± 24.2, P&gt;0.05) dimensions, not statistically differences were found (P&gt;0.05). Conclusion: The recreational futsal program was effective in improving the quality of life in the emotional dimension of overweight and obese children.

Virtual reality use in pediatric patients for orthopedic clinical procedures: A randomized prospective trial of efficacy.

Distraction therapy use such as virtual reality is novel in the pediatric orthopedic field. In this study, we use subjective and objective metrics to evaluate virtual reality efficacy to reduce anxiety and pain in a pediatric orthopedic cohort. A prospective randomized controlled trial included patients between age 5 and 17 years, presenting to a tertiary care pediatric orthopedic clinic. Parallel groups underwent orthopedic procedures in clinic, utilizing immersive and interactive virtual reality distraction therapies versus standard of care. Procedures included cast application, cast removal, bone pin removal, and fracture reduction. All preprocedure parameters were similar between the groups. Primary outcome was the difference between maximum procedural heart rate and baseline. Secondary outcomes included Wong Baker FACES Rating Scale (Wong & Baker, 1988, Oklahoma, USA) for pain and Visual Analog Scale scores for anxiety. Ninety-five patients (66 M, 29 F) underwent 59 cast removals, 26 cast applications, 7 percutaneous pin removals, and 3 fracture reductions. Average patient age in the virtual reality and control cohorts was 10.1 (5-17) and 10.6 (5-17), respectively. Average change in maximum heart rate in the virtual reality and control groups was 10.6 ± 10.1 versus 18.4 ± 11.0 (p = 0.00048). The virtual reality group demonstrated trends toward lower perceived anxiety (1.7 ± 2.8 versus 2.9 ± 3.6, p = 0.0666) when compared to controls. This level 1 study is the first to utilize objective biometric measurements to evaluate use of interactive virtual reality during multiple types of pediatric orthopedic procedures in the clinical setting. The findings suggest that an interactive and immersive virtual reality experience can be effective in reducing pain and anxiety. Level 1, Randomized Controlled Trial.

Position-Specific Movement Characteristics and Heart Rate Profile of Hearing-Impaired Futsal Players: A Simulated Game Analysis

The aim of this study is to compare the movement characteristics and heart rate (HR) response of hearing-impaired futsal players based on their playing positions during a simulated game. The study involved twelve players from the Turkish Deaf Men's Futsal National Team, and PlayerLoad (PL) metrics such as total PL (PLTOTAL), PL per minute (PL·min⁻¹), peak PL (PLPEAK), low to very high PL bands (PLLOW-PLVHIGH), and external load variables such as acceleration (ACC), deceleration (DEC), explosive efforts (EXPEFF), and right/left change of direction (COD-R, COD-L), were analyzed using inertial movement analysis (IMA). Additionally, the internal load metrics, including minimum, average, and maximum HR (HRMIN, HRAVE, HRMAX), percentage of HRMAX (%HRMAX) and percentage of time spent in different HR zones (HRZONE1 to HRZONE4) were continuously monitored. IMA variables and HR metrics, based on playing position, were analysed with the Kruskal-Wallis H test. Group comparisons were conducted using the Mann-Whitney U test, and Bonferroni correction was applied. As a result, PL variables change with notable distinctions between defenders and wingers. Additionally, the PLVHIGH stands out as the only significant difference when comparing wingers and pivots. Wingers generally exhibit different external load, including ACC and COD-L, compared to defenders. Additionally, differences were observed in COD-L between pivots and defenders, as well as in COD-R between pivots and wingers. In conclusion, external and internal load metrics during the simulated game vary depending on the players’ positions in hearing-impaired futsal players, highlighting the importance for coaches to consider this diversity in their athlete monitoring approaches.

Development and Validation of a Prediction Model for 1-Year Mortality in Patients With a Hematologic Malignancy Admitted to the ICU.

To develop and validate a prediction model for 1-year mortality in patients with a hematologic malignancy acutely admitted to the ICU. A retrospective cohort study. Five university hospitals in the Netherlands between 2002 and 2015. A total of 1097 consecutive patients with a hematologic malignancy were acutely admitted to the ICU for at least 24 h. None. We created a 13-variable model from 22 potential predictors. Key predictors included active disease, age, previous hematopoietic stem cell transplantation, mechanical ventilation, lowest platelet count, acute kidney injury, maximum heart rate, and type of malignancy. A bootstrap procedure reduced overfitting and improved the model's generalizability. This involved estimating the optimism in the initial model and shrinking the regression coefficients accordingly in the final model. We assessed performance using internal-external cross-validation by center and compared it with the Acute Physiology and Chronic Health Evaluation II model. Additionally, we evaluated clinical usefulness through decision curve analysis. The overall 1-year mortality rate observed in the study was 62% (95% CI, 59-65). Our 13-variable prediction model demonstrated acceptable calibration and discrimination at internal-external validation across centers (C-statistic 0.70; 95% CI, 0.63-0.77), outperforming the Acute Physiology and Chronic Health Evaluation II model (C-statistic 0.61; 95% CI, 0.57-0.65). Decision curve analysis indicated overall net benefit within a clinically relevant threshold probability range of 60-100% predicted 1-year mortality. Our newly developed 13-variable prediction model predicts 1-year mortality in hematologic malignancy patients admitted to the ICU more accurately than the Acute Physiology and Chronic Health Evaluation II model. This model may aid in shared decision-making regarding the continuation of ICU care and end-of-life considerations.